Characteristics and outcome of spontaneous bacterial meningitis in patients with diabetes mellitus

Virginia Pomar*, Natividad De Benito, Albert Mauri, Pere Coll, Mercè Gurguí, Pere Domingo

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Background: Studies on bacterial meningitis in diabetics patients versus non-diabetics are scarce. In patients with diabetes, bacterial meningitis may have a different presentation, etiology and course. We analyzed and compared the characteristics and outcome of spontaneous BM in adult patients with and without diabetes mellitus (DM). Methods: We performed a single-center, prospective observational cohort study, conducted between 1982 and 2017, in a tertiary university hospital in Barcelona (Spain). The primary outcome measure was in-hospital mortality. Results: We evaluated 715 episodes of bacterial meningitis; 106 patients (15%) had diabetes mellitus. Patients with diabetes were older (median 67 [IQR 17] vs 49 [IQR 40] years, p < 0.001) and more often had a Charlson comorbidity score of ≥3 (40% vs 15%, p < 0.001). Neck stiffness (56% vs 75%, p < 0.001), headache (41% vs 78%) p < 0.001), nausea and/or vomiting (32% vs 56% p < 0.001), and rash (12% vs 26%, p = 0.007) were less frequent in diabetics, whereas altered mental status was more common. Streptococcus pneumoniae and Listeria meningitis were the most common etiologic agents (24 and 18%, respectively). Listeria was more frequent (18% vs. 10%, p = 0.033), whereas meningococcal meningitis was less frequent (10% vs 32%, p < 0.001). Overall mortality was higher in patients with diabetes (26% vs 16%, p = 0.025) concerning non-diabetics. Conclusions: Patients with bacterial meningitis and diabetes mellitus are older, have more comorbidities, and higher mortality. S. pneumoniae and L. monocytogenes are the predominant pathogens, Listeria being more common, whereas Neisseria meningitidis is significantly less frequent than in non-diabetics.

Original languageAmerican English
Article number292
JournalBMC Infectious Diseases
Volume20
Issue number1
DOIs
Publication statusPublished - 20 Apr 2020

Keywords

  • Bacterial infection of the central nervous system
  • Bacterial meningitis
  • Diabetes mellitus
  • Spontaneous meningitis

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